The Field of Dreams works in nostalgic plotlines about baseball, but as I’ve pointed out since the advent of consumer-facing health technologies, there’s no Field of Dreams effect in health care when it comes to consumer health engagement.

U.S. health consumers aren’t using the patient portals that health care providers have built as part of their efforts to bolster health engagement via EHRs and health IT, Xerox found in the company’s 5th annual survey on electronic health records.

I spoke with Tamara St. Claire to discuss the implications of the consumer poll, which was conducted among 2,017 U.S. adults in September 2014.

Most consumers are unaware of patient portals because they haven’t been made aware, St. Claire explained. Physicians are simply not talking with patients about the availability of the portals. “A lot of providers may not be using patient portals because they’re not sure the ROI is there,” St. Claire intuits.

Xerox sees this not as much a technology-patient portal issue but as a patient engagement issue. Patients are moving from playing passive to active roles, and so physician-patient engagement (and measurement) should be integrated into health providers’ strategies for achieving the Triple Aim: lowering per capita costs, improving health outcomes, and driving patient satisfaction through more enchanting care experiences.

Encouraging people to engage with their health data, and especially patient portals, isn’t a one-and-done St. Claire advises. Health providers must meet patients via multiple touchpoints around the life cycle of each patient. And it’s important for the health provider to engage in that conversation while the patient is still in the office or exam room, she believes.

The good news is that health care providers can leverage new technologies in that clinical office moment-of-truth – changing workflow patterns to the front of the office via kiosks, tablets, and mobile technologies.

Some of the most intriguing data points in the survey were that:

Among the 89% of consumers with an ongoing health care provider, only 30% of consumers’ providers talked with them about converting their paper records to electronic format

Among the 90% of consumers familiar with the conversation of paper records to digital records, 41% believe this would lead to more efficient care, 40% think it’s “necessary,” and 32% of people want their medical records to go digital

85% of consumers have concerns about digital medical records, with potential computer hacking being the top concern (for 70% of people) followed by digital records being lost/damaged/corrupted (among 57%), personal information being misused (for 55%), and a power outage preventing clinicians from being able to access the patient’s health information.

On the upside, 57% of consumers say that they’d be more interested and proactive in their own health care if they had online access to their medical records. Across all age groups, the most attractive applications to use on a patient portal would be to schedule appointments, access and review medical records and test results, ask physicians questions, refill meds, and request a referral.

While a majority of consumers across all age groups would prefer to access personal health records on PCs and laptops (78% overall), preferences for mobile access via tablets and smartphones were greater for people under 44 years of age.

In terms of driving traffic to patient portals and the overall health care information embrace, informing people about the existence and benefits of using the portal doesn’t have to be the real-time doctor’s voice, per se – but can be bundled into the clinical experience associated with the physician. The doctor continues to be one of the most trusted touchpoints in health care. That “trust equity” can move from the exam room to the front of the office, where kiosks and mobile tech can engage patients in all sorts of interactions — including but not limited to educating about the existence and benefits of the patient portal and personal health information access.

Trust drives health engagement, and doctors are ranked #2 after nurses and tied with pharmacists in terms of honesty and ethical standards, according to Gallup’s survey released last week.

The Sony hack situation has further shaken U.S. consumers’ perspectives on security of personal information, and several analysts have commented on early impacts for personal health information (PHI). With health consumers largely unaware of patient portals, and concerned about security and confidentiality, health care providers can leverage the Trust Factor along with meeting people where they are in terms of media platforms and channels to promote peoples’ engagement with health information. Building a portal is clearly no guarantee of PHI engagement.

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[…] personal health information, even though most healthcare providers have installed EHR systems. I wrote about Xerox’s (now Conduent’s) fifth annual electronic health records survey bac…, over two years ago, with respect to the Field of Dreams. Xerox’s infographic appears here, […]

She’s just not that into connecting with you (yet), doctor | Health Populi
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4 years ago

Casey and David, thank you for your comments. All are spot-on and emphasize the fact that developers and vendors need to do a much better job at adopting user-centered design principles and understanding both physicians' and patients' pain-points and motivations. David, the "ROI" comment was Xerox's based on their consulting work with physician practices. The mandate for MU may not be pulling through to the end-point of consumers -- in terms of informing people about their existence. I've examined the Xerox's survey data in detail, and this is the case based on their consumer survey.The survey didn't cover physicians, who may well be pushing the portal message to patients. If they are, then a majority of patients aren't hearing or understanding it which gets to the heart of one of my favorite George Bernard Shaw lines -- "The single biggest problem in communication is the illusion that it has taken place."

While this piece's essence is true, that patients are not using portals, I have a few very relevant comments: 1. "U.S. health consumers aren’t using the patient portals that health care providers have built..." Providers do not build portals. IT companies build portals. Most portals used today are poor excuses for portals that are little more than email message tools for patients furnished by the provider's EHR vendor. They do not allow for transmission of multimedia or other digital content (which would be extremely helpful for patients), nor do not allow for the integration of the patient's info from another provider who may have another EHR vendor. 2. "Physicians are simply not talking with patients about the availability of the portals. “A lot of providers may not be using patient portals because they’re not sure the ROI is there..." This is blantantly false. Physicians (or their staff) are pushing patients to know about the portal because of the mandate to do so in order to meet requirements for Meaningful Use. This certainly needs to be qualified with the fact that this interaction might be hurried and brief and just result in one email back and forth which constitutes meeting the requirement (another example of the cat and mouse reimbursement game played between the government and providers which has the patient as an afterthought). 3. Until there are useful and meaningful portals adopted by providers (translation: offered by EHR vendors), the potential for digital patient engagement via the portal is stalled to a halt.

"Building a portal is clearly no guarantee of PHI engagement." Boy howdy. Utility/usability is the watchword in digital communication platforms. If it's easy to use, making what the user is trying to accomplish seamless, simple, and [of course] safe, then you've got adoption rates like a hockey stick. However, no portal technology I've seen yet can check all of those boxes. Many of them took "safe" as the primary goal - safety of the patient data therein presented - and locked that thing down so tight that even a patient has to give him/herself permission to view his/her own records. Repeatedly. It's like a Monty Python sketch as performed by a troupe of mimes. Annoying, purposeless, futile. Better that they take the "seamless" or "simple" box first ... but because a piece of legislation originally titled "Health Insurance Portability and Accountability Act" has become the blunderbuss of "data security and safety, dammit" known as HIPAA, seamless/simple are coded right out of the idea before it can even take root.

Jane is delighted to be invited to speak at the Consumer Healthcare Products Association's (CHPA) annual conference with health care marketers, convening at the historic Hotel du Pont in Wilmington. We'll cover the growing retail health ecosystem and opportunities for self-care, health engagement, and digital health in the expanding IoT for health/care at home.

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